SA Forelimb Flashcards

Question

What are some things that can influence the severity of elbow dysplasia?

Answer 1

* Growth rate * Diet * Exercise They cannot prevent the disease or reduce the potential of the dog to pass it on to its offspring

Answer 2

Use of various genetic or screen tests - radiography Problem is that its not always successful at finding it - but arthroscopy suggests that radiographs poorly predict pathology within the joint

Answer 3

* Extreme example of elbow incongruity * Ulnar is short * Look at anconaeus (beak of bone on more proximal aspect) can appreciate its coming up against caudal aspect of humeral condyles * Look at supratrochlear notch, can appreciate radial head appears to be adjacent * Ulnar isn’t in line with articular surface * Joint incongruity –abnormal pressures in the joint * Can cut the ulnar (leftpic) which allows it to move proximally, so have more congruent joint surfaces

Answer 4

the big condition of the elbow –major consequence of incongruence. Comes under abnormal stress, pressure from humerus, and it fragments and breaks. Articular cartilage is damaged –get loose piece of bone in the joint process

Answer 5

* Large breeds -Rottweiler, Bernese mountain dog, Newfoundland, Staffordshire bull terriers and retrievers (occasionally small breed of dogs) * More males affected than females (2-3:1) * Commonly bilateral disease in 50-90% cases * If you have a case and have early arthritic change, always essential to radiograph the other limb as there are likely changes in the other one also

Answer 6

Males more affected

Answer 7

Commonly bilateral disease in 50-90% of cases

Answer 8

Clinical signs usually by 4-7 months: * variable forelimb lameness, pain on elbow manipulation * Tends to be worse when they have been resting and then they get up * elbow flexion and rotation of antebrachium * If rotate radius and ulnar, animal will often pull back. Always compare one with the other * may have elbow joint effusion –if severely affected. Just caudal to the trochlear ridge, just behind humerus –can sometimes see it, but can feel it * Arthritis becomes then apparent at a later stage. They start off lame in early life, maybe get better and then arthritis kicks in * Watch them as they get up and come into consult room * When they stand–slight outward rotation, limb slightly abducted, taking weight off affected limb

Answer 9

* fissure / fragmentation of the craniolateral part of the MCP * usually a single fragment of the bone when the fissure becomes complete, with attachments to the annular ligament * ±thickened cartilage * ±gross ‘ step ’ between cranial border of articular surface of ulna and radius * ±eburnation resulting in a ‘ kissing lesion ’ on opposing humeral articular surface * Some of the osteochondrosis and cartilage defects–a consequence of damage to coronoid process

Answer 10

Fragmented Medial Coronoid Process Can see step between radial head and ulnar on right pic after it has fragmented off

Answer 11

* Hard to see radiographically * Often wont see it * Sometimes people will do lazy cranio caudal view –let elbow adduct slightly but often you will mainly see secondary changes within the joint –have to extrapolate form this thatitslikelyto dog has a FMCP * CT is best to see – it is whiter than you would expect

Answer 12

* Studies report variable results: some indicate better (short-medium term) outcomes following surgical removal of fragments, others show no benefit compared to conservative management. * DJD progresses with both * Longterm, dogs don’t do well if they have FMCP –short term may be beneficially to remove it, but if you expose subchondral bone, may cause large inflammatory response –so most try to manage these cases conservatively and ONLY REMOVE if you are NOT getting anywhere with conservative management –e.g. rest, NSAIDs and seeing back at regular intervals and keep case under constant review Treatment: Conservative management Surgical options: * arthrotomy or arthroscopy to remove fragment * proximal ulnar osteotomy –morbidity * sliding humeral osteotomy –moving humerus a little, trying to reduce amount of pressure applied to fragmented coronoid and allowing it to heal

Answer 13

Predisposition in retrievers and Newfoundland Greater incidence in males

Answer 14

Bilateral in 50-90% cases

Answer 15

Onset of clinical signs 4-7 months

Answer 16

Increased incidence with increased energy intake (+/- increased Ca/P), growth rate and birthweight (being heavier than other dogs)

Answer 17

* Conservative : exercise restriction, analgesia, nutraceuticals, balanced diet * Surgical : remove flap and debride subchondral bone -blood and mesenchymal stem cell precursors --\> encourage healing by fibrocartilage

Answer 18

Breed disposition: GSD and bassett hounds Frequency is males twice as much as females

Answer 19

* Onset of clinical signs 4-12 months –a little bit later than others * Lameness, pain on elbow manipulation (+ crepitus) • joint effusion(s ) * Bilateral lameness in 11-47% cases –not as bilateral as other forms of elbow dysplasia

Answer 20

Genuine disturbance of minor physis: * anconeal process develops as secondary centre of ossification and is usually fused by 16-20 weeks * failure to fuse (presence of a lucent line) after 20 weeks regarded as abnormal and then it breaks * Form of OCD? -failure to fuse results in AP remaining detached within joint

Answer 21

Conservative * Very poor prognosis with conservative management * Occasionally see these when they are much older, fat elbow and very poor range of movement.

Answer 22

* (a) Removal -variable results: short-term clinical improvement, long term instability and progression of DJD. Use to try and remove it but it a major part of stabilisation of the joint –get much greater progression of OA * (b) re-attachment * 4.0 cancellous screw (lag) and K-wire –trying to screw fragment back into place * poor reduction --\> incongruity still there --\> implant failure * (c) ulnar osteotomy * Good/excellent function in majority of cases * (d) ulnar osteotomy and re-attachment * ‘excellent’ outcome at 18 months with only mild increases in DJD

Answer 23

Mainly spaniels particularly english springer, cocker and cavalier King Charles Also labradors

Answer 24

Clinical signs: * chronic, low-grade, intermittent lameness –this is general presentation, or * acute, severe lameness if condyle fractures * pain on elbow manipulation and pressure applied across condyle * If you squeeze condyle, they will object as you close the fissure between the 2 condyles

Answer 25

Diagnosis: * difficult to see on plain radiographs, obvious on CT. * Fissure likes between 2 parts of condyle and unless you get radiograph parallel to this fissure,you will not see it. * Also get extra bit of bone as when the dog walks, the condyle parts spring apart –which is why new bone forms Incomplete ossification of the humeral condyle (now called humeral intercondylar fissure)

Answer 26

* Conservative: risk of fracture * Surgical: prophylactic transcondylar lag screw although may be associated with morbidity * Run the risk of them getting a condylar fracture if they jump about a lot! Incomplete ossification of the humeral condyle (humeral intercondylar fissure)

Answer 27

End result is DJD/OA

Answer 28

Conservative management * weight control essential Salvage procedures if can’t control pain e.g. joint replacement (dogs), arthrodesis (guarded prognosis), amputation (?)

Answer 29

Supracondylar: * fracture through the supratrochlear foramen * epicondyles symmetrical, but gross instability in supracondylar area Unicondylar * intra-articular * usually lateral condyle

Answer 30

Prognosis generally favourable for single condylar and supracondylar fractures: 64-70% regain ‘reasonable’ function

Answer 31

Young animal –screw Old animal–place lag screw and also a plate on the supratrochlear ridge as pin wont be strong enough and the screw will be what the animal walks on, the intercondylar fissure will never heal –requires support, which is why a plate and a screw is appropriate

Answer 32

* very challenging -refer ! Require 2 plates and a large screw across the condyles –so if you get one, immediately refer to orthopaedic surgeon * marked swelling and instability --\> collapse * intracondylararticular fracture, with supracondylar transverse ( ‘ T ’ ) or oblique ( ‘ Y ’ ) fracture lines • guarded prognosis * Exercise must be restricted post-operatively, but must maintain joint ROM with passive physio and swimming

Answer 33

Treatment options include: Conservative: * bandage or cast -must extend beyond toes to minimise weight-bearing Surgical: * ESF * small plates and screws * (intramedullary pins and wires) * If one or two metacarpal bones intact, acceptable to place a cast or bandage but if more fractured –may need to do something in the way of repair. 3 rd and 4 th most important metacarpals.

Answer 34

Primary: * Osteosarcoma - predilection sites : proximal humerus, distal radius * fibrosarcoma, haemangiosarcoma, chondrosarcoma * synovial cell sarcoma Secondary (metastatic) -less common

Answer 35

* increasingly severe lameness despite analgesia * increasingly severe muscle atrophy * characteristic radiographic changes --\> biopsy

Answer 36

* amputation / limb-sparing + chemo * radiation * palliation (short-term): analgesia

Answer 37

What do you advise client? Some want a Noel Fitzpatrick, but usually followed up with chemo – but it is important to appreciate that the dog will succumb as a result of this particular condition. Amputation? Otherwise, just go for palliation and PTS when time is right

Answer 38

* Often: * chronic lameness * very severe lameness * marked muscle atrophy * older animals * +/-palpable axillary mass * Neurological deficits * Poor response to analgesia

Answer 39

1. Shoulder problems are rare in cats 2. Elbow –osteoarthritis and synovial cysts of the cat is not uncommon 3. (Cats don’t seem to develop elbow ‘dysplasia’) –not something they suffer from

SA Forelimb Flashcards

(63 cards)